الفهرس 
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Abstract
Primary refractory acute myeloid leukemia (AML) and early relapse remain among the most challenging scenarios in the management of AML. Primary refractory or resistant disease as defined by not achieving complete remission (CR) (i.e., a remaining blast count of 5% or more after 1 to 2 cycles of intense induction therapy) occurs in 10% to 40% of the patient population. Alloreactivity is a basis for effective AML treatment. NEACT using haploidentical and higher-order mismatched donors has the potential to harness the potency of alloreactivity without entraining GVHD. This approach is still in the early stages of development. Whether NEACT will become a “blockbuster” treatment or more of a “personalized” therapy, it is a promising platform worthy of careful and creative attention. In our study, seven patients (4 males 57.1 %, 3 females 42.9%) with refractory acute myeloid leukemia (3 primary refractory 42.9%, 4 secondary refractory 57.1 %) were enrolled into this Phase I/II study between February 2013 and March 2014 at clinical hematology and stem cell transplantation department at Maadi Armed Forces Medical Compound. In the present study, we reported an overall response rate of 28.6 % (2 of 7 patients) and a median overall survival rate of 2.53 (95% CI, 1.7 to 3.4) months. As regard univariate analysis, we noticed that less than four previous chemotherapy, fludarabine-free previous chemotherapy and response naïve patients are the factors that were associated with good response to microtransplantation. KIR-ligand mismatch has a little effect on response although it was not-statistically significant (P= 0.067) The primary toxicity of our treatment was neutropenia. However, no patients suffered from acute GVHD or chronic GVHD during any cycles and follow-up period. Administering G-CSF before donor collection potentially enhance the antigen-presenting capabilities of the donor WBC’s and thereby increase the host anti-donor responses, thus increasing the antitumor response. As a phase 2 study, only a limited number of patients have been included (Seven patients), precluding the realization of subgroups’ analysis to evaluate the impact of disease characteristics’ (Cytogenetic, primary or secondary refractory) or donor characteristics’ on patients outcome. However, we correlate different factors with blast percent at D30 to elucidate the factors that may affect response. Microtransplantation is an appropriate therapeutic strategy for older patients with significant comorbidities, and it provides a virtually universal donor pool. Side effects include well-tolerated myelotoxicity and an immediate post-transplantation steroid-responsive immunologic syndrome. The use of G-CSF primed halo-identical microtransplantation appears to be a biologically active therapy in patients with refractory AML. In all, these results provide a framework for the further refinement of the approach designed to improve disease control.